Written by Millie Cossé
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The Phoenix Sepsis Score, which is a novel clinical criterion for pediatric sepsis and septic shock developed using measures of organ dysfunction, outperforms existing IPSCC criteria for the diagnosis of pediatric sepsis and septic shock.
New kid on the block
SEP-3 guidelines clearly define sepsis and septic shock based on evidence of end-organ hypoperfusion in adults, but a comparable definition in pediatric patients has been lacking. Currently, SIRS criteria are used in the evaluation of pediatric sepsis, but SIRS is overly sensitive and lacks adequate specificity. This retrospective cohort study utilized EHR data from 10 hospital-based sites in 5 countries to develop a new scoring system for pediatric sepsis that is based on measures of organ dysfunction.
The authors chose a 4-organ system model which included criteria for respiratory, cardiovascular, coagulation, and neurologic dysfunction. A Phoenix Sepsis Score of 2 or greater in patients with a suspected infection is the sepsis criteria. Septic shock is defined as sepsis with 1 or more cardiovascular points. This criterion has a higher positive predictive value and higher sensitivity when compared to the current IPSCC sepsis, severe sepsis, and septic shock criteria across all settings.
The authors also gave particular attention to validating the criteria in both resource-rich and resource-poor settings, improving overall generalizability.
How will this change my practice?
The improved sensitivity and specificity for identifying pediatric sepsis and septic shock make this a valuable tool that I plan to incorporate into my practice. The score itself (see below) is fairly complicated, which could be a barrier to wide-spread adoption.
Editor’s note: Maybe our friends at MDCalc can come up with a version of this score to help us? ~Clay Smith
Source
Development and Validation of the Phoenix Criteria for Pediatric Sepsis and Septic Shock. JAMA. 2024 Feb 27;331(8):675-686. doi: 10.1001/jama.2024.0196.
